MEDICARE: ROCKINGHAM ASSISTED LIVING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	100908	AK

General Provider Information

NPI Number	:	1003101825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKINGHAM ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	705 W 47TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 W 47TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7111
Country	:	US
Telephone Number	:	907-222-3896
Fax Number	:	907-222-3965

Authorized Official
Title or Position	:	ADMINISTRATOR DESIGNEE
Name	:	LISA STEVENS
Credential	:
Telephone Number	:	907-230-5205

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	06/09/2011

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